Locating a Venous Ulcer for Prompt Treatment

Venous ulcers are slow-healing wounds or sores that typically form in the lower leg's gaiter zone. The leg's gaiter area is a few inches below the knee and above the ankle. The most common location for venous ulcers is on the inner calf, just above the medial malleolus, which is the bony ankle bump on the southernmost part of the tibia.

Without venous ulcer treatment, these open sores often fail to heal within two weeks due to poor blood flow and vein issues that inhibit deoxygenated blood in the lower legs from returning to the heart.

Most venous leg ulcers (VLUs) are associated with chronic venous insufficiency, which can cause stasis (diminished blood flow) and stasis dermatitis on the lower extremities. When stasis and blood pooling cause sores on legs, the leg sore is called a venous stasis ulcer. Venous leg ulcers are also correlated with varicose veins and deep vein thrombosis, which creates blockages in leg veins.

This article discusses how to locate and identify a venous leg ulcer, venous ulcer symptoms, prompt treatment options that can improve blood flow from the legs to the heart, and other ways to help these slow-to-heal wounds get better faster and not recur. 

Man putting on compression socks

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Veins, Blood, and Venous Ulcer Formation

Venous ulcer formation often occurs when blood pools in veins located in the gaiter zone between the mid-calf and ankle. They are typically caused by damage to valves inside leg veins. These valves allow blood pressure in the veins to drop when walking. When these valves are damaged, the blood pressure increases in this area and can form ulcers.

They can also be caused by blood pooling in the lower legs, so conditions like varicose veins and chronic venous insufficiency may also cause venous ulcers to form.

How to Identify Leg or Ankle Venous Ulcers

Early symptoms of venous ulcers include swelling, itching, tingling, and pain in the affected area. The skin around the ulcer can become discolored or hardened.

When identifying a venous leg ulcer, one telltale sign is having a lower calf muscle that looks like an upside-down champagne bottle or inverted bowling pin. In medical terms, a swollen lower leg that resembles an upturned bowling pin or bottom-up champagne bottle is called lipodermatosclerosis

What Are Venous Ulcer Symptoms?

Venous ulcer symptoms often overlap with symptoms of poor lower leg blood flow and chronic venous disease. These include:

  • Lower leg wound or sore that doesn't heal in two weeks
  • Hemosiderin skin staining (reddish-brown gaiter zone skin)
  • Redness around the affected area
  • Open sore with a reddish base and yellow crust
  • Foul-smelling, greenish-yellow discharge
  • Dry, itchy, or scaly skin
  • Taut, hardened skin
  • Lipodermatosclerosis
  • Leg pain and soreness
  • Heaviness in legs
  • Edema (swelling) in lower limbs
  • Varicose eczema (skin problems caused by increased pressure in the legs when veins fail)
  • Thrombophlebitis (vein inflammation due to blood clot)
  • Atrophie blanche (white scar-like plaque around healing sore)

Varicose Veins Are Different from Venous Ulcers

Varicose veins and venous ulcers are both associated with venous insufficiency, which is characterized by insufficient blood flow through lower leg veins back to the heart; however, they're different. Not everyone with varicose veins gets venous ulcers, and people with venous ulcers don't always have varicose veins. 

Treatment to Heal Venous Ulcers

In addition to wound care, the most important part of prompt treatment for venous ulcers is addressing the underlying problem that's preventing healthy blood circulation back up to the heart from the lower legs. It's usually venous insufficiency or chronic venous disease.

As part of compression therapy, compression stockings are the gold standard treatment used to mitigate the root cause of venous ulcers and promote healing. Elevating the legs above the heart while lying down also helps venous blood flow from the lower limbs back to the heart.

Walking, lower-body exercises, and physical therapy can all activate the calf muscle, which promotes venous blood flow from the legs back to the heart as part of a treatment to heal venous ulcers.

Longer-term treatments for venous insufficiency and VLUs may include vascular surgery or venous ablation, which closes off damaged veins and rechannels deoxygenated blood flow through healthier veins that can safely return it to the heart.

Medications that improve blood flow such as hemorrheologic agents may also be prescribed by a healthcare provider once an accurate diagnosis has been made. A 2021 meta-analysis found that a hemorrheologic prescription drug, pentoxifylline, helped venous ulcers heal faster than placebo.

How to Dress a Venous Ulcer Wound

Your healthcare provider will show you how to care for a venous ulcer wound. Keeping the wound clean and bandaged can speed up healing. Clean the wound thoroughly before applying a bandage and moisturize the skin around the wound. After you put the bandage on, wear a compression sock over it.

Before applying a wound dressing, any infected or necrotic (dead) tissue should be removed from the venous ulcer wound; eliminating this slough is called debridement. 

Although it's possible to debride and dress a venous ulcer wound at home, consulting with a healthcare provider and having professional help throughout this process is best.

Untreated Venous Ulcer: Risk and Complications

If left untreated, venous ulcers can become infected and increasingly painful. Treat venous ulcers promptly to avoid complications such as an infection or cellulitis.

Venous ulcers that remain unhealed after four to six weeks are considered chronic leg ulcers. In addition to infection risks and experiencing intense pain, chronic leg ulcers are associated with reduced mobility and decreased quality of life.

Causes vs. Risk Factors

Although venous insufficiency is ultimately the leading cause of venous ulcers, blood flow problems in the lower legs are associated with other risk factors such as smoking, being overweight (having obesity) high blood pressure (hypertension), and diabetes. Addressing these risk factors by losing weight, quitting smoking, lowering blood pressure, and treating diabetes also mitigates the underlying cause of venous ulcers.

Venous Ulcer Not Healing

Roughly 60% of venous ulcers become chronic (long-term) leg wounds. Even with best-practice treatment, up to 30% of venous leg ulcers fail to heal. If you notice signs of infection like redness, odor, fever, or chills, contact your healthcare provider immediately.

Summary

Venous ulcers are wounds or open sores that typically form on the inner lower leg above the ankle. The most common cause of venous leg ulcers is poor blood flow in the veins that return blood from lower limbs to the heart. Along with proper wound care, the key to healing and preventing venous ulcers heal is to do things that improve lower leg circulation like wearing compression stockings, exercising, and getting physical therapy.

In addition to these home remedies, a healthcare provider may refer you to a vascular surgeon or prescribe medicine that improves lower leg blood flow and helps venous leg ulcers heal faster. 

16 Sources
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  1. Probst S, Weller CD, Bobbink P, et al. Prevalence and incidence of venous leg ulcers—a protocol for a systematic reviewSyst Rev. 2021;10(1):148. doi:10.1186/s13643-021-01697-3

  2. Santler B, Goerge T. Chronic venous insufficiency - a review of pathophysiology, diagnosis, and treatmentJDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2017;15(5):538-556. doi:10.1111/ddg.13242

  3. Johns Hopkins Medicine. Venous ulcers.

  4. MedlinePlus. Venous ulcers - self-care.

  5. Bull RH, Clements D, Collarte AJ, Harding KG. The impact of a new intervention for venous leg ulcers: A within‐patient controlled trialInternational Wound Journal. Published online February 13, 2023:iwj.14107. doi:10.1111/iwj.14107

  6. Ghosh SK, Al Mamun A, Majumder A. Clinical presentation of varicose veinsIndian J Surg. 2023;85(S1):7-14. doi:10.1007/s12262-021-02946-4

  7. Alavi A, Sibbald RG, Phillips TJ, et al. What’s new: Management of venous leg ulcersJournal of the American Academy of Dermatology. 2016;74(4):643-664. doi:10.1016/j.jaad.2015.03.059

  8. Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisitedJournal of Vascular Surgery: Venous and Lymphatic Disorders. 2014;2(3):329-334. doi:10.1016/j.jvsv.2013.10.053

  9. Yim E, Kirsner RS, Gailey RS, Mandel DW, Chen SC, Tomic-Canic M. Effect of physical therapy on wound healing and quality of life in patients with venous leg ulcers: A systematic reviewJAMA Dermatol. 2015;151(3):320. doi:10.1001/jamadermatol.2014.3459

  10. Sun SY, Li Y, Gao YY, Ran XW. Efficacy and safety of pentoxifylline for venous leg ulcers: an updated meta-analysisThe International Journal of Lower Extremity Wounds. Published online November 15, 2021:153473462110507. doi:10.1177/15347346211050769

  11. Veith AP, Henderson K, Spencer A, Sligar AD, Baker AB. Therapeutic strategies for enhancing angiogenesis in wound healingAdvanced Drug Delivery Reviews. 2019;146:97-125. doi:10.1016/j.addr.2018.09.010

  12. Gethin G, Cowman S, Kolbach DN. Debridement for venous leg ulcers. Cochrane Wounds Group, ed. Cochrane Database of Systematic Reviews. 2015;2019(9). doi:10.1002/14651858.CD008599.pub2

  13. Quirke M, Ayoub F, McCabe A, et al. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysisBr J Dermatol. 2017;177(2):382-394. doi:10.1111/bjd.15186

  14. Parker CN, Finlayson KJ, Shuter P, Edwards HE. Risk factors for delayed healing in venous leg ulcers: A review of the literatureInt J Clin Pract. 2015;69(9):967-977. doi:10.1111/ijcp.12635

  15. Frykberg RG, Banks J. Challenges in the treatment of chronic woundsAdvances in Wound Care. 2015;4(9):560-582. doi:10.1089/wound.2015.0635

  16. Parker CN, Finlayson KJ, Edwards HE. Ulcer area reduction at 2 weeks predicts failure to heal by 24 weeks in the venous leg ulcers of patients living aloneJ Wound Care. 2016;25(11):626-634. doi:10.12968/jowc.2016.25.11.626

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By Christopher Bergland
Christopher Bergland is a retired ultra-endurance athlete turned medical writer and science reporter.